<div id='add_dialog' style='display:none;' class='form_container'>
	<div class='form-container'>
		<form>
			<fieldset>
				<table>
				<tr>
					<td colspan='2'>
						<input type='hidden' id='service_id' />
						<span id='service_name_span' class='remark'></span>
					</td>
				</tr>
				<tr>
					<td class='label' style='width:200px'>{translate}Surgery catergory{/translate}</td>
					<td class='input'>
					{foreach item=catergory from=$superGroups}
						<input type='radio' name='group' value='{$catergory.group_id}' id='{$catergory.group_id}_radio' 
						onclick="javascrip:changeSurgeryGroup({$catergory.group_id},'_elem_div','elem_group_filter','group_id')" />
						{$catergory.group_name}
					{/foreach}
						<input type='radio' name='group' value='0' id='0_radio' checked='checked'
						onclick="javascript:changeSurgeryGroup('0','_elem_div','elem_group_filter','group_id')" />
						{translate}N/A{/translate}
					</td>
				</tr>
				<tr>
					<td><input type='hidden' id='group_id'/></td>
					<td id='elem_group_filter' class='input' style='display:block'>
					{foreach name=outer item=subGroup from=$subGroups}
						<div id="{$subGroup.elem_div}" style='display:none'>
							<select id="{$subGroup.elem_select}" style='width:100%'>
								{foreach item=item from=$subGroup.group}
								<option value="{$item.group_id}" label="{$item.group_name}">{$item.group_name}</option>
								{/foreach}
							</select>
						</div>
					{/foreach}
					</td>
				</tr>
				<tr>
					<td class='label'>{translate}Surgery type{/translate}</td>
					<td class='input'>
						<select id='type' style='width:120px'>
							{html_options options=$typeList}
						</select>
					</td>
				</tr>
				<tr>
					<td class='label'>{translate}Allowance class{/translate}</td>
					<td class='input'>
						<select id='allowance_class' style='width:120px'>{html_options options=$allowanceClass}</select>
					</td>
				</tr>
				<tr>
					<td class='label'>{translate}Allowance{/translate}</td>
					<td class='input'>
						<select id='allowance' style='width:120px'>
							<option value='X' label='{translate}No{/translate}'>{translate}No{/translate}</option>
							<option value='A' label='A'>A</option>
							<option value='B' label='B'>B</option>
							<option value='C' label='C'>C</option>
						</select>
					</td>
				</tr>
			</table>
			</fieldset>
		</form>
	</div>
</div>